Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC010391 | PA |
N | 111NR0400X | Rehabilitation Chiropractor | AJ010191 | PA |
NPI | 1336444983 |
---|---|
Provider Name | Dr. Kyle Brandon Klim |
First Address | Trappe, PA 19426-2025 |
Second Address | Trappe, PA 19426-2025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2011 |
Last Update Date | 13/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1932329752 | TYPE II GRP NPI (01) | PA |